Healthcare Provider Details

I. General information

NPI: 1477631562
Provider Name (Legal Business Name): HOWARD MARVIN ROSENBERG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 SPRUCE ST PEDIATRIC DENTISTRY
PHILADELPHIA PA
19104-4118
US

IV. Provider business mailing address

202 TOWER RD
VILLANOVA PA
19085-1214
US

V. Phone/Fax

Practice location:
  • Phone: 215-898-7663
  • Fax:
Mailing address:
  • Phone: 610-525-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS017602L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: